Beth and her supervising nurse guided them into Trauma 2, and in seconds, they had the girl stripped, monitored, and an IV line placed. Blood pressure was 60 over nothing. The patient was small and Hispanic and looked about thirteen years old. She was unresponsive, ashen grey, and showed agonal breathing, the gasping for breath of the dying brain. Bright red blood gushed from between her legs. Howard Goldstein, the ER physician was at her side yelling, “Open up that IV and get some plasmanate into her ASAP. Order blood from the lab. Get the GYN tray here now.”
He turned to the EMTs. “What in hell happened to this girl?”
“Her friends said she’d just had an abortion in the apartment house next door. They warned her to wait for the women’s clinic, but she’s undocumented and decided to go ahead.”
Howard’s eyes widened. “Goddamn those butchers putting their hands on these girls. Get in here,” he said to Beth, indicating that she assist him in his examination.
Beth started to grab the sterile drapes for the examination. “No time. Just get some towels under her.”
She grabbed several and placed them under the girl’s buttocks, and then opened the tray for Dr. Goldstein.
The moment he inserted the shiny stainless speculum, parting the lips of the girl’s vagina, dark clots burst out followed by the eruption of bright red blood spraying the room, and soaking Beth and Dr. Goldstein.
Beth gasped. “My God!”
“Keep cool, Beth. Grab a bunch of surgical towels, and get the suction going. We have to see what’s going on.”
When they finally could see into the vagina through the speculum, Howard turned to Beth. “Look at that. The lacerated cervix extends upward into the uterus. Some stupid bastard put his hands on this poor girl. She’s going to require a hysterectomy.”
The girl barely survived the surgery, but lost her uterus and her dreams of being a mother.
This is an omen, Beth thought. A foretaste of what the conservative right would unleash on the women of the United States. The first time they had the opportunity, they’d return to the golden days of religious righteousness when women were slaughtered by the hands of the untrained abortionist or were forced to use a coat hanger or a knitting needle to abort themselves...
As they looked out the window facing the street, another demonstration was in progress. Barbara shook her head in disgust. “Not that it matters any, but I’ve told them over and over again that the Nobody’s Fool Program doesn’t even mention abortion.”
“It’s all political, Barb. When the Girl Scouts participated in the lecture series, the pro-life groups organized a boycott of Girl Scout cookies. Everything is fair game for these people.”
When Beth left the building, she girded herself for the usual verbal onslaught. She’d heard it a hundred times before. She forced her way through the narrow corridor provided by the police against the screaming jeering throng, and then made her way to her car. As she put the key into the driver’s side door, she felt a presence behind her. Alarmed, she turned to face a middle age man in clerical garb and a young woman wearing a tee shirt labeled Evangelicals for Life. The shirt had a realistic image of a fetus sucking its thumb. “You frightened me.”
“I’m so sorry. I’m Reuben Trask from Evangelicals for Life, and this is one of our faithful, Melanie Harper.”
Beth pulled herself together. She’d had similar confrontations before with radical pro-lifers, and knew to remain calm and rational. “It’s nice to meet you Mr. Trask, or is it Reverend Trask?”
“You can call me Reuben.” His smile lit up his face. “If I may, can I ask you what you’re doing with Planned Parenthood.”
“No problem, Reuben. I’m a nurse and an educator. I volunteer my time to Planned Parenthood to educate girls on the things they need to know as they develop into young women.”
Melanie’s face twisted with rage. “You teach them that it’s okay to kill their babies, don’t you?”
“Now, now, control yourself, Melanie. We’re trying to have a civil conversation with,” he paused, “I’m sorry, but I didn’t catch your name.”
“That’s because I didn’t throw it, Reuben, but my name is Beth Byrnes.” She turned to face Melanie. “Your young friend’s bad manners aside, my role is strictly educational, I advocate nothing specific, although it won’t surprise you to hear that I personally support a woman’s right to choose.”
Melanie reddened then began screaming. “You’re nothing but a baby killer, a Nazi who’d kill or perform vile experiments on the unborn. You’re disgusting and your soul will forever writhe in eternal damnation.”
Beth smiled at Melanie and Reuben. “It’s always a pleasure to discuss these issues with thoughtful people having differing views. If you’ll excuse me.”
When Beth entered her car, she noticed Reuben pulling out a small notebook and copying down her license number.
As Beth prepared to drive away, she rolled down the driver’s side window. “And, Reuben, put a muzzle on her, would you.”
Chapter Twenty
Rachel Palmer remained in a deep coma. Every time the phone rang through the night, Jack thought it would announce the end, but when he walked into ICU this morning, not a thing had changed from the evening before.
She looked dreadful as he approached her bedside. The nurses had placed Rachel in one of their four private rooms. Two plastic drains were attached to small red rubber suctions. They exited from her scalp. She had several drains from her abdomen, the largest of which came from the left side below her ribs, the site of the abscess.
Her vital signs were stable and her temperature remained near 101 degrees, not surprising considering the severe infection and its spread throughout the abdominal cavity during surgery.
The duration of her coma concerned them since they had no obvious explanation. It was less than twenty-four hours since she’d finished surgery; perhaps it was still too early to get excited.
Tom sat next to Rachel, holding her hand and whispering softly to her. Maxine sat with her legs and arms crossed, silent and bitter, staring ahead, and refusing eye contact.
“Jack. What’s going on? Why isn’t she awake?” Tom asked.
“I don’t know yet. She was very sick going in, and the surgery was difficult and prolonged. It’s too soon to be thinking the worst. Dr. Brown has gone over her neurologically and he hasn’t seen any signs of brain damage. If she doesn’t come around in a day or so, we’ll begin an evaluation.”
“You’re not keeping anything from us, are you?”
“Absolutely not. You know that’s not my style Tom. What I know, you’ll know.”
On the third postoperative day, Rachel opened her eyes. They searched the room and when they fixed on Tom, her lips formed a broad smile.
Tom bent over his wife, softly kissing her lips. “Welcome back, baby.”
The term hellish, best characterized the next four weeks. Rachel’s mental status never changed. Her speech and movements were turtle-slow, yet if you took the time, she passed the essential elements of a mental status examination; who are you? Where are you? What month is it? She had a hard time with this one sometimes. And finally, who was president? The latter produced, “Barnook Bahama.”
Close enough, Jack thought.
She’d become septic again with high spiking fevers. Each time she did so, they manipulated the drains or probed her wounds at the bedside until they found and drained more infected material. Such manipulations were painful for Rachel and difficult for any of the physicians or nurses to watch. Jack tried morphine and other sedatives, but each time, due to her extreme medication sensitivity, she slept afterward for a day or more.
One morning on rounds, Jack turned to Tom. “I’m ordering a Ken-Air-Bed to prevent bed sores.”
“She doesn’t have any sores, does she?”
“No, but there’s almost no fat, no cushioning between her skin and her bones. Some of those areas are getting red. The next step is skin breakdown and ulcer formation.”
As the weeks passed and the complications continued, Jack noted gradual changes in how physicians, nurses, and even the family began reacting to his continuing efforts on Rachel’s behalf.
Subtle inquiries carried messages: “You’re doing everything you can, Jack. She’s run out of gas.” The less subtle ones went like, “Are you sure you’re doing Rachel or her family any good by persisting this way? Maybe it’s time to discuss options with her family.”
Even Beth, a real fighter, had begun to question what they were doing and why. “Rachel’s suffering Jack…suffering for what? Do you really think she can make it through this and return to a semblance of a normal life?
Rachel and Tom had discussed this between themselves, and she had made her feelings clear. She even signed an advanced directive for health care about her wishes.”
Jack sat with Beth in her office. “Look, you know I’m a big fan of advanced directives and living wills, and they are of great assistance most of the time. Here’s the problem; when you’re healthy and the threat of death or severe disability is an abstraction, people make one decision. When these things threaten you in real time, they become concrete and you may make an altogether different decision. Rational or not, some patients cling to life at any cost.” He paused. “Don’t you think I’ve asked myself these questions a hundred times? I’m sick about this whole thing.”
Even Ben Davidson, the chief of medicine stuck his two cents in yesterday. “You know me, Jack. I’m the last one to pull the plug when there’s any chance. Take another look at Rachel as if you’re seeing her for the first time, and then answer the questions; am I helping her? Does her slight chance justify the inhumanity of the treatment? Is this what Rachel really wants, and finally, am I serving her interests or my own?”
“Easy, boss. We’ve always been on the same page concerning these questions.”
Ben went on. “I know myself, and I think I know you, Jack. We both suffer from fear of failure and have a slight tendency to overindulge our egos. I just want to be sure that Rachel isn’t paying the price.”
Later, Jack was sitting in Beth’s office. She walked around to his back and rubbed his shoulders. “You’re really tight back here, Doctor.”
“These are the toughest cases for me. Mentally, Rachel’s more or less there and it’s not as if she has an untreatable cancer or had irreversible damage to any vital organ. We can make Rachel’s problems better. All it takes is a little luck.”
“Don’t carry the entire burden on your shoulders. Talk it over with Rachel, as best you can, and then talk with Tom and Maxine.”
“I love you, sweetie, but you know that’s not the answer. I’m no computer spitting out objective data. I choose what to tell them, and I know that my choice will determine what decision they’ll make. For better or worse, I’m stuck with me, my beliefs, and biases, and so are they.”
“So, what will you do?”
“I’ll tell them the truth. Medical problems like Rachel’s don’t usually go on indefinitely. They get better or they get worse. If Rachel gets worse, and I think there’s no hope, I’ll tell them and we can decide together to stop treatment.”
Chapter Twenty-One
Jack felt a bit uncomfortable after agreeing to see Sandy Greer, Beth’s friend.
On the morning of Sandy’s appointment, he sat with Beth. “Something usually happens that makes me regret taking on the care of friends or relatives. It’s a mistake to blur the line between physician and friend, for when the going gets tough, the tough call their friends, relatives, and most recently, they blog their complaints about me. Do you know how long something lasts in cyberspace?”
“About a week,” Beth smiled. “Anyway, Sandy’s not like that—she’s great.”
Sandy proved to be delightful. She sat across from Jack’s desk looking great in a light-olive, knee-length skirt and a sheer silk floral blouse that revealed just the right amount of cleavage.
“I’ve heard so much about you, Jack. I think I know you already.”
“Beth was so excited to find you again. You two must have been great friends. She has good friends here, but she always talks wistfully about your times together.”
Sandy brushed away a lock of chestnut hair from her forehead. “She’s a wonderful woman, and you’re a lucky guy.”
Jack took a complete history and physical that immediately clarified one problem in dealing with a friend. Physicians often shy away from certain questions, although nobody denies how important they are, and asking them of a friend was even more difficult. He girded himself and asked them anyway; drugs, alcohol, eating habits, unusual cravings for foods, sexual history, and history of parental or spousal abuse.
Sandy answered the questions forthrightly, although she smiled and lowered her bright blue eyes when responding to Jack’s questions about her sexual history. They were relieved when that part of the questioning was over.
She’d had a mild case of Lupus, an autoimmune disease where the body turns on itself. Some cases are catastrophic when the body attacks its own vital organs like the brain, the kidneys, or even the heart. Mostly, it starts with an assault on the skin, producing skin changes and a characteristic butterfly facial rash.
Sandy’s symptoms had been mild. She had aching joints, mild rashes, and the distinctive facial rash that was barely discernible. Her physicians in Chicago had monitored her closely for signs of other organ involvement, and finding none, kept her treatment simple and limited to the control of symptoms.
Jack examined her. She had a slight redness on her cheeks and above her nose, but nothing else.
Back in his consultation room, he opened her chart. “Your examination is perfectly normal except for the mild butterfly rash. How bad has that rash ever been?”
“When this all started, the red rash was rough and slightly elevated, but with topical cortisone cream it’s always been controllable.”
“I hope you’re not expecting anything too dramatic Sandy. If so I’m going to disappoint you.”
“I’m allergic to the dramatic, Jack. What are you recommending?”
“You wear sun screen when you go out?”
“I apply it before I put on my makeup. I’d use SPF 100 if I could find it. I’d never go outside without it, and I’ve become famous for my wide-brimmed hats.”
“Make sure that the sunscreen protects against both UVA and UVB otherwise, I think that we should continue with what you’ve been doing all along. As long as the disease stays this mild, I advise no alteration in your treatment. I’m sure you’ve been through the treatment options if your Lupus gets worse?”
“You mean high dose cortisone, anticancer drugs, and new antibody treatments?”
“Yes. None of these highly toxic treatments is justifiable in your case. I suspect that they’ll never be.”
“Well, that’s reassuring.”
“Let me know if anything develops or if your symptoms become a problem for you. If you have a flare, I want to see you at once. Make an appointment to see me again in four months.”
Harmony Lane had no illusions about the nature of the women who found her practice appealing. They had been, and would continue to be, challenging. She knew the medical literature on fibromyalgia, chronic fatigue syndrome, and medical ecology. She had attended national meetings where they presented the newest thoughts about these difficult illnesses.
It was rare, but it happened. Sometimes, even Harmony found it difficult to deal with certain women patients. She understood that aspects of modern life, and even physiology, placed an unfair burden on women. In part, this helped to explain their behavior, but at times, she couldn’t dispel the pejorative that flashed through her mind. They were words that disgusted her when they came from the mouths of others, especially from men; wimpy, weak, and wuss were a perfect trifecta, and when combined with the words melodramatic, irrational, neurotic, and her all-time favorite, hysterical, she began to think of herself as a traitor to her sex.
E
dna Robinson was such a patient. Arnie Roth, one of the kindest and most sympathetic family practitioners in the Brier community referred her. If Arnie was having problems with Edna, Harmony smelled trouble ahead.
She entered the examining room. Edna wore one of Harmony’s blue robes and sat on the examining table.
The wailing assault arrived even before Harmony had a chance to greet her patient. “I’m a wreck, Harmony. You’ve got to do something.”
“Good morning, Edna. I was about to ask you how you’re feeling, but I guess I’ll skip that step now.”
Edna looked at Harmony with curiosity.
When Arnie referred Edna with the diagnosis of fibromyalgia, Harmony applauded his creative sense of humor in labeling her as such. When Harmony reviewed Edna’s medical records, she acquitted Arnie of all blame. Edna joined his practice when she moved into the bay area. A physician in Detroit had suggested the diagnosis of fibromyalgia and Edna was thrilled to have a name for her symptoms. She lovingly embraced that diagnosis and fought against anyone suggesting otherwise. Try as he may, Arnie was unable to shake the diagnosis from her fervent embrace.
Harmony did a complete history and physical and a detailed laboratory evaluation. The criteria for making the diagnosis of fibromyalgia were soft, and Edna fulfilled only a few of them, but not enough to sustain that diagnosis.
Try and tell her that, Harmony thought. Edna had become this disease, and nothing could shake her conviction.
Harmony used her best tactics. She was sympathetic and never dismissed Edna’s symptoms and problems, but even the suggestion that she might have other than her beloved fibromyalgia, led to weeping and wailing, Edna’s body literally thrashing in Harmony’s office. When Harmony, in her most tactful way, suggested that seeing a psychiatrist might be helpful, Edna reacted as if she’d recommended cyanide.
The Plague Within (Brier Hospital Series) Page 11
